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CULTIVATING SYMPTOM MANAGEMENT EXPERTISE ON AN INPATIENT ONCOLOGY UNIT.
Deborah Mast, RN, BSN, OCN®, Beverly Caraher, MSN, RN, AOCN®,
CHPN, Judith Paice, PhD, RN, FAAN, Maribeth Mielnicki, BSN, RN, OCN®,
and Kari Foote, MS, RN, OCN®, Northwestern Memorial Hospital, Chicago,
IL.
Effective symptom management for patients with cancer is essential throughout
the cancer care continuum. Processes that enhance symptom management expertise
among staff remain essential to the continuous improvement of oncology
nursing care. Research on symptom severity ratings indicates that caregivers
and healthcare providers, with the exception of hospice care providers,
tend to underestimate patients’ symptoms. The symptom experience,
in the absence of expert nursing and collaborative symptom management,
adversely affects patients’ self-care and coping abilities and their
quality of life, so the development of excellent symptom assessment and
effective symptom management skills is a high priority for caregivers.
To determine the prevalence of symptoms in the oncology inpatient population
and to evaluate the nursing staff’s ability to accurately identify
these symptoms, we performed two separate evaluations. The first, a patient
interview, assessed a convenience sample of 30 patients for the presence
of the following symptoms: pain, nausea and vomiting, diarrhea, constipation,
sadness, anxiety, and shortness of breath. Of this group of patients,
87% (26 of 30) reported at least one of these symptoms. The second evaluation
included a separate chart review of 30 inpatient records upon admission,
revealing that 60% of these patients reported symptoms. Of the patients
identified by chart review as symptomatic, 95% were identified by the
admitting nurse as having at least one symptom, while 68% were identified
by the house staff as symptomatic.
Strategies to improve overall symptom management in our setting have included
the appointment of a symptom management nurse as a resource for nursing
staff and house staff physicians, as well as an educational effort entitled
“Symptom Management: Improving Quality of Life.” The educational
program, including pre- and post-testing, began with an 8-hour continuing
education program and is now continuing with monthly inservices on symptom
management including presentations and posters on specific symptoms. As
our staff’s collective proficiency in symptom management continues
to increase as a result of expert mentoring, role modeling, and education,
we hope to significantly improve symptom management in our inpatient oncology
population.
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